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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study was conducted to assess radiographically the thymus size in well and sick neonates and to search for a possible relationship to perinatal events. Thymus size was expressed as cardiothymic:thoracic ratio (CT/T) by measuring the width of the cardiothymic shadow at the level of carina and dividing it by the width of the thorax at the costophrenic angles. The CT/T was measured on chest radiographs obtained on day 1 in well term neonates consecutively born in our nursery and sick neonates with meconium staining of the amniotic fluid, meconium aspiration syndrome or respiratory distress syndrome (RDS). Neonates with congenital anomalies, congenital heart disease or intrauterine growth retardation were excluded. There were no significant relationships between CT/T and sex, birth route, birthweight or gestational age in well and sick term neonates. The CT/T were comparable among well and sick term neonates and were significantly greater in the preterm neonates with RDS than in the preterm neonates without RDS. The CT/T was correlated to the birth route only in the preterm neonates. We conclude that thymus involution in the perinatal period is a complex process and the response is different between term and preterm neonates.
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PMID:Thymus size and its relationship to perinatal events. 1097 42

Mask-applied continuous positive airway pressure (CPAP) has been shown to reduce morbidity among patients with acute respiratory distress in the setting of cardiogenic pulmonary edema. OBJECTIVE: To determine a minimum percentage of patients transported by ALS for difficulty breathing who could potentially benefit from a pre-hospital trial of CPAP. METHODS: Paramedic run sheets were collected from consecutive, adult, ALS transports for a chief complaint of difficulty breathing over a 6 week period in a large urban EMS system. Demographic information, medical history, vital signs, clinical assessments, and transport times were abstracted into a database by trained reviewers. Strict criteria for CPAP were defined in advance as "acute respiratory distress," meaning (1) respiratory rate > 25 and (2) labored or shallow breathing, and "presumed cardiogenic pulmonary edema," meaning (3) a prior history of heart disease and (4) presence of bilateral rales on exam. RESULTS: Data from 240 consecutive run sheets were compiled. Median patient age was 66 years old, with females outnumbering males 168 to 81. A total of 15 spontaneously breathing patients met all 4 criteria for CPAP. Four of these patients were either hypotensive (SBP < 90) or had potential for airway compromise (i.e., obtundation), making CPAP inadvisable. Among the 11 remaining patients (4.4% of all transports for difficult breathing), median transport time was 20 minutes (range 14-31 minutes). CONCLUSIONS: Using very strict criteria, a small but not significant percentage of patients are optimal candidates for a prehospital trial of CPAP. Transport times would appear to justify this type of intervention. A prospective study is currently under way to test the feasibility of administering CPAP to such patients in the prehospital setting.
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PMID:EMS transports for difficulty breathing: is there a potential role for CPAP in the prehospital setting? 1101 53

We report 2 cases of transposition of the great arteries associated with anomalous pulmonary venous connection emphasizing the clinical findings, the diagnosis, and the evolution of the association. One of the patients had the anomalous pulmonary venous connection in its total infradiaphragmatic form, in the portal system, and the other patient had a partial form, in which an anomalous connection of the left superior lobar vein with the innominate vein existed. At the time of hospital admission, the patients had cyanosis and respiratory distress with clinical findings suggesting transposition of the great arteries. The diagnosis in 1 of the cases, in which the anomalous connection was partial, was established only with echocardiography, without invasive procedures that would represent risk for the patient; in the other case, in which the anomalous connection was total, the malformation was only evidenced with catheterization. The patients underwent surgery for anatomical correction of the heart disease. Only 1 patient had a good outcome.
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PMID:[Echocardiographic diagnosis of transposition of the great arteries associated with anomalous pulmonary venous connection]. 1150 Jul 49

N-terminal pro-atrial natriuretic peptide [proANP(1-98)] has been extensively investigated in patients with chronic heart failure and ishemic heart disease. It is found to be a better marker of cardiac dysfunction than atrial natriuretic peptide (ANP). The possible involvement of proANP(1-98) in cardiac depression caused by sepsis has not been studied yet. Therefore, we analyzed atrial plasma concentration of proANP(1-98) in 17 septic patients with hemodynamic variables measured or calculated using pulmonary artery catheter. The results of altogether 96 measurements show a significant negative correlation of proANP(1-98) and cardiac index (p<0.024), oxygen delivery (p<0.03) and oxygen consumption (p<0.03). There is also a positive correlation with pulmonary vascular resistance (p<0.03). ProANP(1-98) is significantly higher in patients who developed acute respiratory distress syndrome (ARDS) (p<0.001). This study implies that proANP(1-98) is a possible novel hormone marker of cardiac depression caused by sepsis that could be used for prediction of ARDS.
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PMID:Pro-atrial natriuretic peptide hormone from right atria is correlated with cardiac depression in septic patients. 1150 93

Failure of the ductus arteriosus to close within 48-96 hours of postnatal age results in a left to right shunt across the ductus and overloading of the pulmonary circulation. This is more likely to happen in premature neonates with respiratory distress syndrome. Deterioration in the respiratory status on day 3-4 in a ventilated neonate and unexplained metabolic acidosis may be the earliest indicators of a patent ductus arteriosus (PDA). Indomethacin is the main stay of medical management of PDA in preterm neonates. Guidelines for administration of indomethacin have been described in the protocol. Restricted fluid therapy may be beneficial in the prevention of PDA in preterm neonates. Presence of PDA in a term neonate should be investigated to rule out an underlying congenital heart disease.
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PMID:Patent ductus arteriosus in preterm neonates. 1175 38

The majority of congenital diaphragmatic hernias (CDH) occur through the foramen of Bochdalek; herniation through the foramen of Morgagni (MH) is rare. Fifteen children (12 males and 3 females) with congenital MH (7 right, 3 left, 5 bilateral) were treated over a period of 15 years, comprising 11% of a total of 135 children with different types of CDH. The majority (12, 80%) had repeated chest infections. In 1 the hernia was discovered accidentally during evaluation of trauma, and another presented in the neonatal period with acute respiratory distress (ARD). The diagnosis was made on plain lateral chest radiograph when there was anterior herniation of bowel loops, and in these cases the diagnosis was confirmed by barium enema. Computed tomography was useful in preoperative diagnosis when the hernia contents were solid. All patients were operated upon transabdominally except 1, and in all cases there was a hernia sac. Associated anomalies were present in 10 (66.7%) patients: 4 (26.7%) had malrotation, 4 (26.7%) congenital heart disease, and 3 (20%) Down's syndrome. Our study shows a relatively high frequency of MH in our patients. MH rarely presents in the neonatal period, but when it does, it causes ARD. The majority of patients with MH present beyond the neonatal period with repeated attacks of chest infection, and although late-presenting MH is relatively benign, it nevertheless causes significant morbidity. Thus, clinical awareness and early diagnosis and surgical treatment are important factors.
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PMID:Herniation through the foramen of Morgagni: early diagnosis and treatment. 1195 70

Sudden Unexplained Death Syndrome (SUDS) is a major health problem in rural residents of Northeast Thailand. The cause of death in SUDS is suspected to be cardiovascular abnormalities. As magnesium (Mg) and zinc (Zn) deficiency contribute significantly to several cardiovascular diseases, we investigated the Mg- and Zn-status of patients with sudden respiratory distress and cardiac arrest who had survived resuscitation attempts or a near-SUDS episode (N-SUDS). The following subjects were enrolled: 12 N-SUDS inhabitants of rural Northeast Thailand (rural group 1, R1), 13 rural villagers with no past history of N-SUDS (rural group 2, R2), 15 urban Northeasterners (urban group 1, U1); 13 Bangkokians (urban group 2, U2). All subjects were free of structural heart disease. Magnesium and zinc were assessed by atomic absorption spectrophotometry of samples of plasma, red blood cells (RBC), white blood cells (WBC), and 24-hour urine. The mean levels of magnesium in the RBC, WBC, and 24-hour urine of N-SUDS patients (R1) were significantly lower than those of the urban groups (U1 and U2), while the plasma levels did not show any differences. When comparing the Zn-status of R1 with that of the urban groups (U1 and U2), the plasma, RBC, and WBC levels were found to be significantly lower in R1 (except for the RBC-Zn of the U1 group), while the 24-hour urine levels was higher. Although the magnesium and zinc parameters were not significantly different between the rural groups R1 and R2, the prevalence of hypomagnesuria (<2.2 mmol/day), hypozincemia (<9.7 micromol/l), and hyperzincuria (>10.7 micromol/day) was higher in the R1 group. These findings suggest that the homeostasis of both magnesium and zinc is altered in N-SUDS patients. Similar alterations, to a lesser degree, were observed in those people living in the same rural environment (R2).
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PMID:Magnesium and zinc status in survivors of sudden unexplained death syndrome in northeast Thailand. 1211 48

The records of all the infants admitted during the first 7 days of life in the Pediatrics Ward of JIPMER hospital, Pondicherry, from November 1991 to October 1992 were analyzed. The total admissions in the early neonatal period were 169, of which 60 were preterm and 109 were term infants. Out of 169 admissions, 65 neonates died (55 within 7 days and 10 after the age of 7 days), 90 were discharged, and 14 left against medical advice. In the first 6 hours of life 90% of admissions were preterm, then term admissions progressively increased as the postnatal age increased. The mortality rate for preterm was high if admitted at 7-24 hours of age in comparison to term infants where mortality was similar, except when admitted after 72 hours of age. The maximum number of deaths occurred if gestation was or = 32 weeks (63%) or weight 1000 g (75%). After 32 weeks of gestation mortality was similar (34-38%). Mortality was 46-47% between 1000 to 1999 g and then decreased to 30-33% if weight was more than 2000 g. Before coming to hospital only 49.7% of the neonates received exclusively breast milk, 22% were not fed at all, and 42.87% were given either cow's milk, sugar water, or a combination of the two, with or without partial breast feeding. The mortality rate was 28.57% in those exclusively breast fed, it was 63.6% in those who were not fed at all, and 42.87% in those receiving sugar water and cow's milk. Morbidities observed were systemic infections (36.69%), birth asphyxia and birth injuries (30.76%), congenital anomalies (5.32%), respiratory distress syndrome (4.73%), congenital heart disease (2.45%), hemolytic disease of the newborn (Rh incompatibility - 2.37%, ABO incompatibility 1.18%) and hemorrhagic disease of the newborn 1.77%). However, 8.87% of all cases were preterm infants and 2.30% were term babies with intrauterine growth retardation. Systemic infections caused 52.30% of deaths followed by birth asphyxia and injuries (29.23%). In preterms, systemic infections caused 69.50% of deaths, followed by respiratory distress syndrome (17.34%). In term infants, both infections and birth asphyxia contributed equally to mortality (42.86% each).
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PMID:Early neonatal morbidity and mortality pattern in hospitalised children. 1231 97

Congenital heart disease (CHD) occurs in 8 per 1000 live births, with approximately one third of these neonates requiring intervention in the first month of life. Neonates with respiratory distress, cyanosis, feeding difficulties, low cardiac output, or dysmorphic syndromes commonly have CHD. Clinical suspicion increases in a symptomatic infant with a heart murmur, but the presence or absence of a murmur does not assure either the presence or absence of significant congenital heart disease. Infants suspected to have CHD may be divided into premature and term infants, as well as infants with duct-dependent pulmonary blood flow, infants with duct-dependent systemic blood flow, and infants with unrestricted pulmonary blood flow. This article will also address the specialized clinical situations of total anomalous pulmonary venous return, transposition of the great arteries, and hypoplastic left heart syndrome with intact atrial septum.
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PMID:The neonate with suspected congenital heart disease. 1245 Jan 56

Nitric oxide (NO) inhalation therapy relaxes preconstricted pulmonary blood vessels without causing concomitant systemic hypotension and increases oxygen uptake into the blood. NO inhalation is a new treatment for various disorders of neonates (respiratory distress syndrome, persistent pulmonary hypertension, congenital heart disease and congenital diaphragmatic hernia). There is no references of its use in congenital cystic adenomatoid malformation (CCAM). We report a case of a newborn of 33 week's gestation. The infant underwent resection of the CCAM that had occupied the right middle lobe. At the end of the operation, arterial blood gases at a fractional inspired oxygen concentration (FiO2) of 1.0 reveled acidosis and severe hypoxemia probably due to persistent pulmonary hypertension. NO therapy was used for 16 hours with decreased oxygen need and increase of arterial blood oxygen data. According to the extent of the adenomatoid lesion, likely due to the compression of the surrounding tissue, these patients at times postoperatively develop difficulty in oxygenation and ventilation and the changes are similar to those patients with congenital diaphragmatic hernia. The use of NO in these disorders are successfull.
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PMID:[Use of nitric oxide in a newborn child with pulmonary cystic adenomatoid malformation]. 1260 21


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